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Journal of Ultrasonography Jun 2021Morton's neuroma is a painful lesion of the interdigital nerve, usually at the third intermetatarsal space, associated with fibrotic changes in the nerve, microvascular...
Morton's neuroma is a painful lesion of the interdigital nerve, usually at the third intermetatarsal space, associated with fibrotic changes in the nerve, microvascular degeneration, and deregulation of sympathetic innervation. Patients usually present with burning or sharp metatarsalgia at the dorsal or plantar aspect of the foot. The management of Morton's neuroma starts with conservative measures, usually with limited efficacy, including orthotics and anti-inflammatory medication. When conservative treatment fails, a series of minimally invasive ultrasound-guided procedures can be employed as second-line treatments prior to surgery. Such procedures include infiltration of the area with a corticosteroid and local anesthetic, chemical neurolysis with alcohol or radiofrequency thermal neurolysis. Ultrasound aids in the accurate diagnosis of Morton's neuroma and guides the aforementioned treatment, so that significant and potentially long-lasting pain reduction can be achieved. In cases of initial treatment failure, the procedure can be repeated, usually leading to the complete remission of symptoms. Current data shows that minimally invasive treatments can significantly reduce the need for subsequent surgery in patients with persistent Morton's neuroma unresponsive to conservative measures. The purpose of this review is to present current data on the application of ultrasound for the diagnosis and treatment of Morton's neuroma, with emphasis on the outcomes of ultrasound-guided treatments.
PubMed: 34258038
DOI: 10.15557/JoU.2021.0022 -
The Journal of the American Academy of... Sep 2008
Review
Topics: Foot; Foot Diseases; Humans; Metatarsalgia; Neuroma
PubMed: 18768712
DOI: No ID Found -
Journal of Foot and Ankle Research Sep 2023Surgical resection of Morton's neuroma includes dorsal and plantar approaches. However, there is no consensus on the choice of approach in clinic. The purpose of this... (Meta-Analysis)
Meta-Analysis Review
BACKGROUND
Surgical resection of Morton's neuroma includes dorsal and plantar approaches. However, there is no consensus on the choice of approach in clinic. The purpose of this study was to conduct a systematic review and meta-analysis to compare the surgical results of dorsal and plantar approaches.
METHODS
The literatures of PubMed, Cochrane library, Embase and Web of Science were searched on April 26th, 2023. A systematic review was performed using the Preferred Reporting Items for Systematic Reviews and Meta-Analysis guidelines. The data were extracted after screening the literature and evaluating the quality of the methodology included in the study. The RevMan5.4 software was used to analyze and calculate the OR value and 95% confidence interval.
RESULTS
A total of 7 randomized controlled trials and comparative studies were published, of which only 5 were included. There were 158 feet via plantar approach (plantar group, PG) and 189 via dorsal approach (dorsal group, DG). There was no significant difference between PG and DG in overall adverse events, sensory problems, incision infection and deep vein thrombosis (pā>ā0.05). In terms of scar problems, PG showed more than DG (OR, 2.90[95%CI, 1.40 to 5.98]; pā=ā0.004). Other outcome indicators such as visual analogue scale (VAS) scores and American Orthopedic Foot and Ankle Society (AOFAS) scores were difficult to be included in the comparison.
CONCLUSIONS
Based on the relatively low quality and small amount of available evidence, the meta-analysis conducted produces a hypothesis that the frequency of adverse events in surgical treatment of Morton's neuroma, dorsal approach and plantar approach may be the same, but the types are different. More high-level evidence is needed to further verify this hypothesis.
Topics: Humans; Morton Neuroma; Consensus; Lower Extremity; Orthopedics; Software
PubMed: 37674248
DOI: 10.1186/s13047-023-00660-w -
International Orthopaedics 1992During the past 10 years we have operated on 75 feet for Morton's neuroma with a minimal follow up of nine months. Associated anomalies were found in 80%. Pathological...
During the past 10 years we have operated on 75 feet for Morton's neuroma with a minimal follow up of nine months. Associated anomalies were found in 80%. Pathological studies demonstrated that the lesion was irritative in nature. The clinical results were satisfactory in 94%.
Topics: Adolescent; Adult; Aged; Female; Follow-Up Studies; Foot Diseases; Humans; Male; Middle Aged; Neuroma; Toes
PubMed: 1428347
DOI: 10.1007/BF00182715 -
Foot and Ankle Clinics Sep 2014Interdigital neuromas are a common cause of forefoot pain, and approximately 80% of patients require surgical excision for symptom relief. Although 50% to 85% of... (Review)
Review
Interdigital neuromas are a common cause of forefoot pain, and approximately 80% of patients require surgical excision for symptom relief. Although 50% to 85% of patients obtain relief after primary excision, symptoms may recur because of an incorrect diagnosis, inadequate resection, or adherence of pressure on a nerve stump neuroma. The symptom relief rate after reoperation is similar to that after primary excision. A plantar longitudinal incision provides optimal exposure, and transposition of the nerve stump into bone or muscle and avoids traction or pressure on the nerve ending that can result in a painful stump neuroma. Preoperative counseling is essential to align patient expectations with potential outcomes.
Topics: Humans; Neoplasm Recurrence, Local; Neuroma; Recurrence; Reoperation
PubMed: 25129354
DOI: 10.1016/j.fcl.2014.06.006 -
Yeungnam University Journal of Medicine May 2019Forefoot disorders are often seen in clinical practice. Forefoot deformity and pain can deteriorate gait function and decrease quality of life. This review presents... (Review)
Review
Forefoot disorders are often seen in clinical practice. Forefoot deformity and pain can deteriorate gait function and decrease quality of life. This review presents common forefoot disorders and conservative treatment using an insole or orthosis. Metatarsalgia is a painful foot condition affecting the metatarsal (MT) region of the foot. A MT pad, MT bar, or forefoot cushion can be used to alleviate MT pain. Hallux valgus is a deformity characterized by medial deviation of the first MT and lateral deviation of the hallux. A toe spreader, valgus splint, and bunion shield are commonly applied to patients with hallux valgus. Hallux limitus and hallux rigidus refer to painful limitations of dorsiflexion of the first metatarsophalangeal joint. A kinetic wedge foot orthosis or rocker sole can help relieve symptoms from hallux limitus or rigidus. Hammer, claw, and mallet toes are sagittal plane deformities of the lesser toes. Toe sleeve or padding can be applied over high-pressure areas in the proximal or distal interphalangeal joints or under the MT heads. An MT off-loading insole can also be used to alleviate symptoms following lesser toe deformities. Morton's neuroma is a benign neuroma of an intermetatarsal plantar nerve that leads to a painful condition affecting the MT area. The MT bar, the plantar pad, or a more cushioned insole would be useful. In addition, patients with any of the above various forefoot disorders should avoid tight-fitting or high-heeled shoes. Applying an insole or orthosis and wearing proper shoes can be beneficial for managing forefoot disorders.
PubMed: 31620619
DOI: 10.12701/yujm.2019.00185 -
American Journal of Orthopedics (Belle... Jan 2008
Topics: Female; Foot Diseases; Humans; Magnetic Resonance Imaging; Male; Metatarsal Bones; Nerve Degeneration; Ultrasonography; Weight-Bearing
PubMed: 18309386
DOI: No ID Found -
Journal of Manipulative and... Jun 1991Morton's "neuroma" is a perineurofibrosis of an interdigital nerve. The authors describe various factors that may be responsible for the development of this lesion and...
Morton's "neuroma" is a perineurofibrosis of an interdigital nerve. The authors describe various factors that may be responsible for the development of this lesion and relate this information to two case histories. In these cases, treatment with manipulation, various physical therapy modalities, and/or foot orthotics, resulted in the successful resolution of symptoms.
Topics: Adult; Chiropractic; Female; Foot Diseases; Humans; Hydrotherapy; Middle Aged; Neuralgia; Ultrasonic Therapy
PubMed: 1919367
DOI: No ID Found -
The Journal of Foot and Ankle Surgery :... 2020Minimally invasive nerve decompression for operative management of Morton's neuroma has been shown to be an effective alternative to neurectomy; however, little is known... (Review)
Review
Minimally invasive nerve decompression for operative management of Morton's neuroma has been shown to be an effective alternative to neurectomy; however, little is known about postoperative outcomes. In this retrospective case series, we reviewed 27 procedures in 25 patients who underwent minimally invasive nerve decompression as primary surgical management for Morton's neuroma. Most subjects (22, or 88%) had 12 or more months of health plan enrollment postoperatively; 3 (12%) had 4 to 7 months of enrollment after the procedure. Postoperative patient satisfaction, complications and the need for a follow-up neurectomy were ascertained from medical record review. Additionally, demographic and clinical data were extracted from electronic sources. Patient satisfaction was unknown for 5 (18.5%) of the 27 procedures. Among the 22 (81.5%) procedures for which there were valid patient satisfaction data, patient satisfaction was excellent for 11 (50%); good for 2 (9.1%), and poor for 9 (40.9%). During the follow-up period, 5 (18.5%) patients required an open neurectomy. Among the 6 (22.2%) patients who presented without a Mulder's sign on physical exam preoperatively, 83% reported excellent results. Minimally invasive nerve decompression may not be as effective as previously seen; however, it may be indicated in patients presenting with absence of a Mulder's sign, a physically small or nascent neuroma.
Topics: Decompression; Humans; Morton Neuroma; Neuroma; Neurosurgical Procedures; Retrospective Studies
PubMed: 32830016
DOI: 10.1053/j.jfas.2020.05.011 -
AJR. American Journal of Roentgenology Apr 2018Central metatarsalgia relates to abnormalities of the second, third, and fourth metatarsals and their respective metatarsophalangeal joints. A variety of disorders... (Review)
Review
OBJECTIVE
Central metatarsalgia relates to abnormalities of the second, third, and fourth metatarsals and their respective metatarsophalangeal joints. A variety of disorders present with central forefoot pain; they range from traumatic lesions (acute or chronic repetitive), inflammatory and infective disorders, nonneoplastic soft-tissue lesions, and benign tumors to malignant lesions. Patients often present with symptoms of localized pain in the forefoot that worsens on weight bearing (walking or running), which can be sharp or dull and often is perceived as a lump felt inside or underneath the foot and described as walking on a marble or pebbles. These patients are labeled as having central metatarsalgia and are further evaluated with ultrasound or MRI to establish a diagnosis.
CONCLUSION
In this article, we review metatarsal and intermetatarsal lesions of the foot that present with central forefoot pain and a sensation of walking on pebbles, focusing on conditions mimicking Morton neuroma clinically or on imaging. We also briefly review some other plantar lesions and arthropathy that can present with awareness of lump underneath the foot.
Topics: Bursitis; Contrast Media; Cumulative Trauma Disorders; Diagnosis, Differential; Fractures, Stress; Ganglion Cysts; Granuloma, Foreign-Body; Humans; Joint Instability; Magnetic Resonance Imaging; Metatarsalgia; Morton Neuroma; Neoplasms; Osteonecrosis; Ultrasonography
PubMed: 29470159
DOI: 10.2214/AJR.17.18460